Fixing houses for better health in remote communities
Tess McPeakea and Paul Pholerosb
a Indigenous Housing and Infrastructure Branch, Australian Government Department of Families, Community Services and Indigenous Affairs
b Director, Healthabitat Pty Ltd
- 1. Introduction
- 2. What are the specific Indigenous housing issues?
- 3. Government research and policy development
- 4. What do FHBH projects aim to achieve?
- 5. Background and key concerns of FHBH projects
- 6. FHBH project information
- 7. Financial information
- 8. Community response to FHBH projects
- 9. Benefits of FHBH: Kitchen design
- 10. Why are the results so poor at Survey Fix 1?
- 11. Conclusion
- Endnotes
- References
1. Introduction
Many Indigenous Australians live in substandard overcrowded houses, often in remote areas. Poor housing is a major contributor to unsafe environmental conditions that lead to the spread of communicable diseases. Australian research has shown that to maintain good health among residents, the 'health hardware' (toilets, lights, drains, taps, showers and kitchens) of most houses in an Indigenous community must function most of the time (Pholeros, Rainow & Torzillo 1993). Ultimately, Indigenous housing should be well designed, soundly constructed and maintained in good working order.
This paper will consider specific Indigenous housing issues; summarise the origins, objectives and financial details of, and community responses to, projects under the Fixing Houses for Better Health (FHBH) Program; and provide evidence to debunk common myths about the causes of the poor function of Indigenous housing. FHBH projects operate in rural and remote communities or public housing tenanted by Indigenous people across Australia.
2. What are the specific Indigenous housing issues?
Safe housing protects residents from electrocution, fire, gas leakage, explosion or asphyxiation; exposure to contaminated water and waste-water, use of dangerous materials (such as lead-based paint and asbestos); and the threat of structural collapse due to termite damage, rust or rot caused by excessive moisture.
Healthy housing provides residents with functioning health hardware to improve their health and reduce the pool of infectious diseases such as diarrhoeal disease, skin infections, pneumonia, eye infections, and other common infectious diseases found in many remote area Indigenous communities (Australian Government Department of Family and Community Services 2003).
Sustainable housing depends on good initial design, sound construction and ongoing cyclical maintenance. These actions require a workforce of Indigenous housing managers with the capacity to supervise local maintenance teams; inspect new constructions and upgrades; access technical advice; and coordinate community consultation, especially in the design phase.
3. Government research and policy development
Before the policy changes announced in 2001, Australian Government funds were mainly expended on building new houses with fewer resources used for housing maintenance. Better housing that meets agreed standards, is appropriate to the needs of Indigenous people, and contributes to their health and wellbeing, are key desired outcomes of Building a Better Future: Indigenous Housing to 2010 (Housing Ministers Advisory Committee (HMAC) Standing Committee on Indigenous Housing 2001). 'Safe, healthy and sustainable housing for Indigenous Australians' was originally introduced as a new policy direction in the National Framework for the Design, Construction and Maintenance of Indigenous Housing (Commonwealth, State and Territory Housing Ministers' Working Group on Indigenous Housing 1999).
Over the past five years, the Australian Government has been working with state, territory and regional governments to develop sustainable housing assessment and maintenance systems in Indigenous communities. A series of FHBH projects has assessed and fixed health hardware in 2,400 houses across Australia.
4. What do FHBH projects aim to achieve?
Fixing Houses for Better Health projects aim to secure better health for Indigenous Australians living in rural and remote communities by improving the physical environment in which they live and sustaining this improvement over time. The Maintaining Houses for Better Health component of FHBH projects employs and trains local community members to maintain health hardware in working order and encourages communities to take responsibility for ongoing maintenance after the FHBH has improved the health hardware.
However, these gains might be unsustainable if appropriate design and construction principles are not incorporated into Indigenous housing in the first place. Therefore, a longer-term objective of FHBH is to promote the adoption of better design and construction methods for new and upgraded Indigenous housing. To this end, FHBH data have been included in the National Indigenous Housing Guide to quantify the extent of safety and health hardware problems, clarify the nature of design, construction or maintenance issues and target detailed solutions.1
5. Background and key concerns of FHBH projects
What started as a small public and environmental health review in Central Australia in the mid 1980s (Nganampa Health Council, South Australian Health Commission and Aboriginal Health Organisation of South Australia 1987) has gradually grown in many states and is now a national program that aims to make urgent safety and health hardware repairs to existing housing and surrounding living areas.
The FHBH Program and Housing for Health (HfH) projects have a number of aims, which are listed below.
- Immediate changes are made by ensuring that 'fix' work commences on the first day of every project.
- All work is prioritised on the basis of maximum health gain (the priority of healthy living practices is explained in more detail below).
- Defined, standard, and repeatable tests of a house and its components are used to collect accurate and detailed data. This ensures that small-scale immediate improvement goes hand-in-hand with careful documentation of longer-term needs and basic housing faults.2
- Local Indigenous people are employed on every project, ensuring that some local people receive 'on-the-tools' training about how to test and do minor fix work on their houses.
- Licensed tradespersons are employed to carry out more extensive fix work within 24 hours of the project's commencement.
- Data generated by projects is used to expose building and product faults and to help define the principles essential for better design, specifications, construction and maintenance.
Figure 1 shows a comparison of average house function for 11 critical healthy living practices. The data range from safety to nutrition and were collected before Survey Fix 1 (SF1) and after Survey Fix 2 (SF2) in all FHBH and HfH projects between 1999 and 2006.
Figure 1: All HfH and FHBH projects: comparison of national average function rates for critical healthy living Practices at Survey Fix 1 and Survey Fix 2
6. FHBH project information
FHBH projects use the HfH approach to assess and fix health hardware. The approach has a safety and health focus and is underpinned by a philosophy of 'no survey without service'. The first round of projects was known as FHBH1 and was funded in 1999–2000 through the Aboriginal and Torres Strait Islander Commission. These projects surveyed and fixed health hardware in 969 houses in 29 communities for a total of $3.5 million.
In the 2001 Commonwealth Budget, the then Department of Family and Community Services (FaCS) was allocated $9 million over four years to continue funding FHBH projects. In 2001–02 and 2002–03, FHBH2 projects assessed and fixed health hardware in 434 houses in 11 communities for a total of $3 million. In 2003–04, FHBH3 projects assessed and fixed health hardware in 446 houses in 12 communities for $3 million. In 2004–05, FHBH4 projects assessed and fixed health hardware in 545 houses in 19 communities for $3 million.
FHBH projects were run in rural and remote communities, with the majority in very remote locations. This complicated the logistics of hiring licensed tradespeople, obtaining consumables and parts, and managing the maintenance component of FHBH projects-known as Maintaining Houses for Better Health (MHBH). State and territory governments and regional councils identified staff to be trained in the HfH method during FHBH projects and allocated resources to support these staff. More than 400 Indigenous people were trained in basic maintenance and employed on the survey teams, hired as trade assistants during the fix work stage or as MHBH workers for ongoing work. Where funding was available, MHBH workers continued to be employed within the housing maintenance team.
7. Financial information
Funds were allocated at a rate of $5,000 per house, although the actual amount spent on each house depended on its condition. FHBH projects expended funds on:
- fees for project managers, licensed trades, data managers, finance managers and MHBH trainers, including travel and accommodation costs
- wages for survey fix3 team members, trainee managers and MHBH workers
- the purchase of all materials, consumables, tools and testing equipment
- the hiring of office space and purchase of lunches and cleaning services
- national program advice, data analysis, administrative assistance and reporting.
FHBH used an outsourced management model to minimise departmental administration costs. Healthabitat provided the HfH process and general advice and assistance, while consultants, familiar with the HfH process, were contracted to manage the projects in the field. The process immediately engaged the community in action, was closely monitored under licence and was overseen by a workforce of accredited professionals. Where possible, FHBH funds were integrated with state or territory government maintenance funding to maximise the benefits to householders. For example, an Indigenous community housing organisation paid for living-room floors to be tiled in all houses during the fix work stage4; and a state government Indigenous housing authority purchased hot water units for installation in identified homes.
8. Community response to FHBH projects
During and after a FHBH project, Indigenous community housing officers found that residents tended to report faults more readily because they knew that the FHBH team would fix them quickly. This increased the likelihood that faults were reported early and reduced overall maintenance costs. Community housing managers reported that the projects reinforced the connection between fixing taps and drains and toilets and better, more healthy living.5 In one project, FHBH activities were combined with a Scabies Day activity to raise awareness about the importance of washing clothes and bedding.
Householders spoke about the FHBH workers 'giving a lot back to their community' and workers said they enjoyed the challenge of surveying houses and making sure every house was checked. Some workers suggested running the tests and checks once a month. In several communities, FHBH workers continue to be employed to check and repair health hardware as part of the MHBH team set up during the project. Housing managers are better able to budget and plan maintenance activities after a FHBH project because they can use data from the surveys as a baseline for future work.
9. Benefits of FHBH: Kitchen design
FHBH and HfH surveys have repeatedly shown very poor function rates for kitchens. For example, of the 4,038 houses surveyed between 1999 and 2006, only 6 per cent provided residents with facilities to store, prepare or cook food. In 2000, FaCS funded the design and specification of a modular kitchen that would be safe and easy to install, easy to clean and maintain, reduce insect and vermin habitats, and use robust, good quality materials. An expert steering group reviewed the design before it was manufactured and installed in Indigenous houses with different climatic conditions. High-use components of the design were data logged6 and the components listed below were monitored for 12 months.
- Access to kitchen cupboards was recorded each time a door was opened.
- Stove use was recorded each time a stove was used and the duration of use, hot plates and/or oven use.
- Sink use was monitored, including when the sinks were used and the depth of water used.
- Refrigerator temperatures were monitored throughout the trial period.
This trial confirmed the efficacy of the design and informed detailed specifications. The kitchen design is currently being promoted and marketed to the Indigenous housing sector.
10. Why are the results so poor at Survey Fix 1?
The results in Figure 1 raise a key question: why are the initial SF1 results so poor? The most common explanations given are based on myths as set out below. These broad myths often stand in the way of both policy development and detailed design improvement. Detailed information drawn from the FHBH and HfH projects has been presented below to test these often publicised myths or 'theories'.
Tenant damage
While described in many ways, the most common explanation offered for the poor performance of houses is 'tenant damage, or misuse or misunderstanding of how to use the house'. This frees policy makers, departments, designers and builders of much responsibility, as whatever gets built will be damaged regardless of the house.
Figure 2 shows that the prime cause of need for fix work in the surveyed houses was not damage but routine maintenance. The second major reason for repairs was faulty installation or workmanship; this may be related to the self-certification of trades introduced in the past decade.
Figure 2: National fix work (all FHBH and HfH projects) showing fix reason, as reported by licensed tradespeople (1999–2006)
Age of housing stock
Myth: Much Indigenous housing stock is old and the figures simply reflect this fact. This pushes debate to the arena of provision of new housing. Usually combined with the need for new housing is the need for many new houses often reducing their budget and decreasing specification levels for new houses. New housing will perform better than old.
While much Indigenous housing is old and the figures do reflect this fact, there is no clear evidence that new housing performs better than old. Figure 3 compares age and overall function for approximately 900 houses in widely scattered communities around Australia. The figure tests two versions of the same premise-that newer houses should perform better than older houses or, older houses should not perform as well as newer houses.
Figure 3: Relationship between age of house and average house function
In this figure, the broken line represents the average age of houses in each project community and the dotted line represents the average age of all houses in all projects. Eight projects had houses that were older than the average age of all houses in all projects. The solid grey columns represent projects in which houses were older than average and where house function was higher than average. The downward diagonally marked columns represent projects in which houses were younger than average and where house function was less than average.
Figure 3 demonstrates that in 16 of the 23 project sites, the relationship between age of house and average house function does not confirm the prediction that 'as a house gets older its ability to function decreases' or conversely 'younger houses have better house function'.
Reducing the cost of new houses so that we can build more of them, in order to address real problems of overcrowding, could reduce the money spent on key specification items, leading to loss of house function. Common 'reductions' include:
- little or no insulation
- smaller or lower capital cost hot water system with high running costs
- reduced quality of tapware
- reduced door and window quality
- reduced number and quality of light fittings
- fewer inspections of the works
- no verandas, yard works or fencing.
Poor design
Myth: Inappropriate design has not allowed people to interact with the house properly and the house has not provided for the needs of those using it. More and better informed consultation at the design stage will improve the performance of housing.
Design and detailed specification do contribute to the performance of houses. Robustness of the house's fittings, hot water system and waste system in response to overcrowding and aggressive water7 quality should definitely be considered. Areas needing better design, careful specification and detailing include:
- waste water systems able to cope with regularly higher house populations
- hot water systems, considering water quality, running costs and house population
- bathroom layouts and floor drainage able to cope with large numbers of people and floor drainage
- shower rose selection that recognises poor water quality
- light fittings and energy saving bulbs or tubes
- doors and hardware, particularly locks
- windows and new ways of insect screening that allow privacy, ventilation and still permit egress in the event of a fire
- cooktops and ovens able to cook for many families and for large meals
- kitchen bench splashbacks
- kitchen storage units
- solutions to keeping food cool and pest-free
- usable yard areas with cooking, sleeping, shade, food production and storage potential
- in hot weather, thermal performance8 inside and around the house at least equivalent to sitting outside the house under a tree.
Poor construction
Myth: Buildings are built badly and therefore fail. They need to be built of stronger materials and generally in a more robust fashion.
As previously shown in Figure 2, damage is not the major issue, nor is 'making the house more robust' if the robustness is solely to counter vandalism.
Figure 4 shows the high level of routine maintenance faults that may well have been caused by poor initial construction or poor specification of key building components. For example, drains with minimal falls are more likely to become blocked by heavy use. More disturbing is the fix work required due to plumbing and electrical work being assessed by licensed trades as faulty. Over 25 per cent of all fix work by licensed trades (or over 10,000 electrical, plumbing and general repairs) was due to the original work being considered faulty - whether installed incorrectly, the wrong part or component being fitted or the essential item being absent from the house. Poor construction coupled with lack of supervision leads to houses that do not function. Consultation, design and specification will not produce better housing unless it is ensured that decisions made during the design process are carried out on the building site.
Figure 4: Detailed breakdown by trades of fix work needed by reported reason (1999–2005)
Poor data
Myth: The data do not properly reflect the condition of Indigenous housing. Housing is far better than these data would indicate. Other state and national data show the better performance of housing.
There has been constant criticism of the project data, perhaps because it tells an unpalatable story not just about house function but also about the final product of the entire Indigenous housing delivery and maintenance system. Typical criticisms have been: 'The questions are too hard and no house would pass!' The simple test is to examine the questions in detail. For example, with the shower performance test, ask yourself which of the following seven items you would not want in your house when showering tomorrow morning9:
- hot water supplied to the shower with pressure
- cold water supplied to the shower with pressure
- hot water temperature above 44˚C
- hot water tap working
- cold water tap working
- shower rose working
- shower drainage working.
Myth: The data are collected by Indigenous teams who are untrained.
The teams are given training in the field, first on demonstration boards with electrical and plumbing fittings able to be tested and fixed. Team leaders supervise the workers in the field and the data sheets are checked at various stages to ensure accuracy. As the majority of the survey/fix teams come from the participating community, they quickly see that the marks they make on the survey form and their own fix work lead directly to a licensed tradesperson fixing the house and therefore have every reason to ensure accuracy. Figure 5 shows the proportion of Indigenous staff employed on these projects.
Figure 5: comparison of Indigenous and non-Indigenous staff numbers working on FHBH/HfH projects
Myth: What use are the data? They are too complex.
The data are first, and most importantly, used to identify fix work in the house so that immediate change can occur. At the end of each project completed, recommended works and future works on a house-by-house and a trade-based breakdown are left with each participating community. Nationally, common faults identified in houses throughout HfH and FHBH projects have been documented and included in the second edition of the National Indigenous Housing Guide (Australian Government Department of Family and Community Services 2003).
11. Conclusion
Housing for Health and Fixing Houses for Better Health projects continue the challenging task of making small but important improvements in the day-to-day living environment for Indigenous communities.
Fixing Houses for Better Health projects generate savings for Indigenous community housing organisations by identifying and fixing safety and health hardware faults before they become larger and more expensive problems. The MHBH component represents an important opportunity for local community members to be employed in a practical program of regular checks and repairs to essential hardware. The data collected through FHBH projects illuminates the way to better:
- Indigenous housing design for new buildings and the upgrading of existing buildings
- construction and maintenance
- products and materials
- expert research on critical knowledge gaps.
Most of all, FHBH projects demonstrate that it is possible, even with small amounts of well-targeted money, to achieve improvement in the living environment of Indigenous people in Australia.
Endnotes
1. The National Indigenous Housing Guide is a practical, technical manual for everybody involved in the design, construction or maintenance of Indigenous housing. It is structured around the healthy living practices framework and highlights issues that need to be considered by designers, builders, engineers, tradespeople and maintenance workers. The guide is currently being reviewed to update the data and technical information. It is expected that a third edition will be available in 2007.
2. A total of 253 checks and tests are carried out on each house.
3. Survey fix: the part of a FHBH project where houses have their function assessed and urgent fix work is completed.
4. Fix work stage: the part of a FHBH project where most repairs (fix work) are completed.
5. Focus groups were conducted with Indigenous community members, housing managers and FHBH workers in three locations during FHBH2.
6. Data logger: A small electronic device used to store various types of information over time. For example, the temperature of the main living room of a house is sampled every hour for six months and then this information can be downloaded into a computer.
7. Aggressive water: Water that does damage to pipes, taps or any part of the water system because it is either acidic or alkaline or contains high levels of minerals.
8. Thermal performance: How a house responds to varying external temperatures to benefit the occupant, for example, if it is 40˚C outside the house and 42˚C inside the house, the house would have poor thermal performance.
9. Shower performance: Determined by the whether a shower passes seven standard repeatable tests including whether hot water is available, the water temperature is over 44˚C, cold water is available, both the hot and cold water taps are working, the shower rose is working and the shower drain is working. All these elements are need for the shower to be deemed to be performing.
References
Australian Government Department of Family and Community Services 2003, National Indigenous Housing Guide-improving the living environment for safety, health and sustainability, 2nd edition, Canberra.
Commonwealth, State and Territory Housing Ministers' Working Group on Indigenous Housing 1999, National framework for the design, construction and maintenance of Indigenous Housing-overview, Aboriginal and Torres Strait Islander Commission, Canberra.
Housing Ministers Advisory Committee (HMAC) Standing Committee on Indigenous Housing 2001, Building a better future-Indigenous housing to 2010, HMAC, Canberra.
Nganampa Health Council, South Australian Health Commission and Aboriginal Health Organisation of South Australia 1987, Uwankara Palyanyku Kanyintjaku (UPK)-an environmental and public health review within the Anangu Pitjantjatjara Lands, Alice Springs, Northern Territory.
Pholeros, P, Rainow, S & Torzillo, P 1993, Housing for Health-Towards a healthy living environment for Aboriginal Australia, Healthabitat, Newport Beach, New South Wales.